Fluid Overload Research Articles

Implementing the Nurse-led Optimization of Volume and blood pressure - Enabling at multi-Levels using TechnologY (NOVELTY) program for Chronic Kidney Disease: a prospective cohort study.

Fluid overload is a common manifestation of chronic kidney disease (CKD) and is associated with increased hospitalizations and death. However, severe symptomatic fluid overload is potentially preventable with early recognition of mild fluid overload and timely institution of appropriate pharmacotherapy and fluid restriction. We implemented and evaluated the outcomes of a nurse-led clinic that incorporated objective fluid volume assessment using body impedance analysis (BIA) into structured patient education and action plan coaching to patients with CKD and fluid overload. Single-center prospective pre- post implementation study of adults who participated in the program (Table 1) between August 2022 and April 2024. Patients were eligible if they had CKD not requiring dialysis and had fluid overload and/or systolic blood pressure (BP) >160 mmHg or diastolic BP >100 mmHg. The clinical effectiveness outcomes were symptoms and signs of fluid overload and improvement in blood pressure. The patient-reported effectiveness outcomes were chronic disease self-management assessed using the Partner in Health (PIH) questionnaire and health-related quality of life (HrQOL) assessed by the EuroQOL-5 Dimension (EQ5D5L) survey. The clinical safety outcomes were hypotension and worsening kidney function. Among 107 patients referred to the nurse-led program, 96 attended the first visit. median age was 68.5 (IQR 60.2, 77.3) years and eGFR was 21.6 (14.0, 39.7) ml/min/1.73 m2. Almost all participants (93.8%) had symptoms of fluid overload within the past 1 month before the first review. BIA was performed for 52 (54.2%) patients and the median overhydration was 2.4 (1.3, 3.6) liters. The second and third visits were attended by 38 (39.6%) and 28 (29.2%) patients, respectively. At program completion, patients had reduced symptoms and signs of fluid overload and had improved systolic BP [137 (121, 143) versus 151 (132, 166) mmHg, p=0.03] and self-management [PIH score 96 (89, 104) versus 72 (57, 88), p=0.001] compared to their baseline visit. EQ5D5L scores were significantly different. None experienced hypotension (systolic BP <90 mmHg) and kidney function did not change significantly during follow-up. A nurse-led program that incorporated objective fluid volume assessment, structured patient education and action plan coaching for patients with CKD and fluid overload improved BP and self-management.

Lymphatic Drainage in Patients with Heart Failure: A Feasibility Study.

Lymphatic dysfunction contributes to congestion and end-organ damage in heart failure (HF), yet current therapies do not directly target lymphatic congestion. Thoracic duct (TD) drainage offers a novel approach to address this gap. This multicenter feasibility study evaluated the safety and feasibility of minimally invasive TD drainage in patients with HF. Four patients with New York Heart Association class II-IV HF and fluid overload underwent fluoroscopy-guidedTD access via cervical, abdominal, or transvenous brachial approaches. Lymph was drained by gravity for up to 3 hours, and hemodynamic changes were measured. TD drainage was successful in all patients, with a mean lymph output of 430 mL. Mean reductions in right atrial and pulmonary capillary wedge pressures were 4 mmHg and 1.5 mmHg, respectively. No major adverse events occurred. TD drainage appears feasible and safe, with potential decongestive benefits. Larger studies are needed to confirm its role in HF management.

FLUID OVERLOAD MODIFIES HEMODYNAMIC IMPACT OF CONTINUOUS RENAL REPLACEMENT THERAPY: EVIDENCE OF A COVERT CARDIORENAL SYNDROME?

Background: Fluid overload (FO) in critically ill children correlates with higher morbidity and mortality rates. Continuous renal replacement therapy (CRRT) is commonly employed to manage FO. In adults, both FO and CRRT adversely affect myocardial function. It remains unclear if children experience similar cardiovascular effects. Methods: Observational single-center study on children (<18 years) receiving CRRT at Texas Children's Hospital from 11/2019 to 3/2021. Excluded were those with end-stage renal disease, pacemakers, extracorporeal membrane oxygenation, ventricular assist devices, apheresis, or without an arterial line. Electrocardiometry (ICON Osypka Medical GmbH, Berlin, Germany) which is noninvasive and utilizes bioimpedance, was applied to obtain hemodynamic data over the first 48 h of CRRT. Our aim was to identify how FO >15% affects hemodynamics in children receiving CRRT. Results: Seventeen children, median age 43 months (interquartile range [IQR] 12-124), were included. The median FO at CRRT initiation was 14.4% (2.4%-25.6%), with 9 (53%) patients having FO >15%. Differences were noted in systemic vascular resistance index (1,277 [IQR 1088-1,666] vs. 1,030 [IQR 868-1,181] dynes/s/cm 5 /m 2 , P < 0.01), and cardiac index (3.90 [IQR 3.23-4.75] vs. 5.68 [IQR 4.65-6.32] L/min/m 2 , P < 0.01), with no differences in heart rate or mean arterial pressure between children with and without FO. Conclusion: FO affects the hemodynamic profile of children on CRRT, with those having FO >15% showing higher systemic vascular resistance index and lower cardiac index, despite heart rate and mean arterial pressure remaining unchanged. Our study illustrates the feasibility and utility of electrocardiometry in these patients, suggesting future research employ this technology to further explore the hemodynamic effects of dialysis in children.

Multiorgan Dysfunction and its Association With Congestion and Outcome in Aortic Stenosis Treated WithTAVI.

Degenerative severe aortic stenosis (AS) is treated by valve replacement to improve outcome. Despite diagnostic advancements, many AS patients are still diagnosed late with advanced heart failure. The aim of the study was to assess multiorgan dysfunction in severe AS using blood biomarkers and their association with quantitative fluid levels and clinical outcomes after transcatheter aortic valve implantation (TAVI). Consecutive AS patients undergoing TAVI received comprehensive preinterventional assessment with serum biomarker profiles reflecting organ dysfunction and quantitative fluid overload (FO) using bioelectrical impedance spectroscopy. FO by bioelectrical impedance spectroscopy was defined according to a previously established cut-off (≥1.0 L). Time to first heart failure hospitalization or death served as composite primary endpoint. Among 880 patients (age 81 ± 7years, 47% female), 41% had FO and 89% had biomarker abnormalities of at least one domain. Ascending fluid levels were independently associated with distorted biomarkers across domains of myocyte stress, hepatic dysfunction, renal dysfunction, inflammation, and anemia. After 2.4±1.0years of follow-up, 27% had reached the primary endpoint (29 heart failure hospitalization, 194 deaths, 13 both). Biomarkers across all domains were individually and independently associated with outcomes. In a multidomain approach, every affected extra-cardiac domain was associated with a 71% increase in event hazard (adjusted HR: 1.71; 95%CI: 1.39-2.11). Also, for each domain, the combination of distorted biomarkers and FO had the highest event risk. Biomarker abnormalities are highly prevalent in severe AS, influenced by congestion, and associated with impaired prognosis post-TAVI. Multiorgan dysfunction faces a particularly dismal outcome.

Heart Failure and Sepsis-Related Mortality Trends in the United States, 1999 - 2019: An Analysis of Gender, Race/Ethnicity, and Regional Disparities.

Heart failure (HF) and sepsis are significant causes of disease burden and mortality among the elderly population of the USA. HF causes fluid overload, which complicates the treatment approach when patients develop sepsis necessitating fluid resuscitation. While individual disease states have been studied extensively, the trends in mortality for concurrent sepsis and HF are not well known. Mortality trends due to sepsis and HF in individuals aged 65 and older in the USA from 1999 to 2019 were analyzed using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Differences in age-adjusted mortality rate (AAMR) and average annual percent change (AAPC) over the past two decades based on gender, race, region, and place of death were examined. Between 1999 and 2019, there were a total of 5,887,799 deaths related to HF, 2,584,523 deaths related to sepsis, and 250,115 deaths related to both HF and sepsis. There was also a decrease in AAMR for HF-related (AAPC -0.80%) and sepsis-related (AAPC -0.28) deaths but an increase in combined HF and sepsis-related AAMR (AAPC 1.06%). Men had consistently higher AAMRs compared to women and a greater increase in mortality (AAPC in men 1.53% vs. women 0.56%). African American patients had a higher AAMR than White patients throughout the study period, though the difference narrowed. African Americans saw a decrease in overall HF and sepsis-related AAMR from 48.90 to 40.56 (AAPC -0.83), whereas AAMR for the White population increased from 27.26 to 33.81 (AAPC 1.37). Regionally, the Northeast had the highest AAMR in 1999 (32.32) but decreased to the lowest AAMR by 2019 (30.77). Totally, 203,368 (81.31%) of all deaths related to HF and sepsis were in medical facilities, 18,430 (7.37%) were in home/hospice facilities, and 24,713 (9.88%) in nursing homes. HF and sepsis-related mortality in the elderly population increased over the past two decades, with men and African Americans at disproportionately higher risk.

Maternal cardiovascular dynamics in twin pregnancies complicated by twin-to-twin transfusion syndrome.

Twin pregnancies affect maternal circulation by increasing the circulating blood volume and enlarging the uterus due to excess amniotic fluid. Nevertheless, how twin-to-twin transfusion syndrome (TTTS) affects maternal circulation remains unclear. Our aim was to examine maternal circulation changes at TTTS onset. This cohort study was conducted at the Toho University Omori Medical Center from October 2022 to September 2023. Patients were divided into three groups, singleton pregnancy (singleton), uncomplicated monochorionic diamniotic (MD) twin pregnancy (nMD), and TTTS groups. We prospectively collected echocardiographic data to evaluate the left ventricular function, left ventricular contractility, diastolic performance, and inferior vena cava diameter. Thirty-one, 17, and 18 patients were assigned to the singleton, nMD, and TTTS groups, respectively. The left ventricular end-systolic volume (ESV) was significantly lower in the TTTS group than in the nMD group [ESV: 23.9 ± 9.2 mL vs. 13.3 ± 8.4 mL]. The left ventricular end-diastolic volume (EDV) was no significant difference, but a decreasing trend in the TTTS group than in the nMD group. The left ventricular ejection fraction was significantly lower in the nMD group than in the TTTS group [72.2 ± 6.4% vs. 80.1 ± 5.9%]. The heart rate was significantly higher in the TTTS group than in the other two groups. Cardiac output was similar among the groups. MD twin pregnancy with TTTS may decrease circulating blood volumes. Maternal cardiac function may be adapted to compensate for cardiac output in patients with TTTS.

Efficacy of Peritoneal Dialysis in Acute Kidney Injury in Neonates with Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia.

We aimed to evaluate the efficacy of peritoneal dialysis (PD) in hypoxic-ischemic acute kidney injury (AKI) in newborns with hypoxic-ischemic encephalopathy (HIE) who underwent therapeutic hypothermia (TH). This was a retrospective study including the newborns with HIE/TH who developed hypoxic-ischemic AKI and underwent PD between January 2022 and June 2024. The blood test results obtained before starting PD were compared with the blood test results obtained just before the decision to terminate PD or, in case of death, with the final blood test results obtained before death. Twenty-one newborns were included in the study. Four (19%) of these newborns were diagnosed with moderate HIE, and 17 (81%) were diagnosed with severe HIE. The median gestational age of the patients was 38 (36-39) weeks, and the mean birth weight was 3083 ± 494 g. The median postnatal day when PD started was 3 (2-4) days and its duration was 7 (4-10) days. All patients had fluid overload as an indication for PD dialysis, and fluid overload was accompanied by hyperkalemia in 8 (38.1%) patients. After PD, blood pH, bicarbonate, and sodium values increased significantly (p ≤ 0.001, 0.009, <0.001, respectively), and potassium, phosphorus, and creatinine values decreased significantly (p ≤ 0.001, <0.001, 0.031, respectively) compared with the predialysis values. PD corrects acidosis and electrolyte imbalance and may be considered as a successful renal replacement therapy for hypoxic-ischemic AKI in neonates with HIE/TH, especially in units with limited resources.

Development and validity of tutorial guide for using lung ultrasound to identify “Excessive Fluid Volume” nursing diagnosis in patients with heart failure

Development and validity of tutorial guide for using lung ultrasound to identify “Excessive Fluid Volume” nursing diagnosis in patients with heart failure

Experience of continuous kidney replacement therapy in a tertiary care unit of a lower-middle-income country.

Information on the clinical characteristics and outcomes of children undergoing continuous kidney replacement therapy (CKRT) from lower-middle-income countries (LMIC) is limited. Records of consecutive children 1month to 18years of age who underwent CKRT from Jan 2016 to Jan 2024 in a tertiary care pediatric intensive care unit (PICU) were retrospectively reviewed and analyzed for clinical and machine-related characteristics, and outcomes. Over the 8-year period, 102 patients (61.8% boys) with median age 4 (1.5-9) years underwent CKRT. Among these, 52 (51%) weighed < 15kg, 37 (36.3%) were underweight, and 27 (26.5%) were stunted. Mean (SD) PRISM III score at admission was 17 (6.8), with 94.1% of patients ventilated and 90.2% on two or more inotropes at CKRT initiation. Septic shock (28.4%) and inborn errors of metabolism with acute decompensation (23.5%) were the most common diagnoses at PICU admission. Indications for CKRT were fluid overload, hyperammonemia or inborn errors of metabolism with acute decompensation, dyselectrolytemia, or their combination in 33.3%, 32.4%, 5.9%, and 19.6% patients, respectively. Continuous veno-venous hemodiafiltration (CVVHDF) was the most common (60.8%) modality employed, with an effluent dose of 32.8 ± 7.3ml/kg/h. Despite heparin anticoagulation in 87.2% patients, circuit clot occurred in 28 patients, 18 (17.6%) of which led to termination of CKRT session. Overall mortality was 75%. CKRT can be safely performed in critically ill children from LMIC despite the presence of significant undernutrition and multi-organ dysfunction. Further studies from similar settings are required to evolve strategies to identify modifiable risk factors for the observed high mortality.

Aetiology of pleural effusion among patients with chronic kidney disease

Background: Pleural effusion is common in patients with chronic kidney disease (CKD). Aetiology of pleural effusion is diverse like heart failure, tuberculosis (TB), pneumonia, uraemia etc. Proper diagnosis of the cause is necessary as treatment plan varies from case to case. This study was designed to evaluate the aetiology of pleural effusion in patients with CKD. Methods: This cross-sectional study was conducted in the Departments of Nephrology and Dialysis, Internal Medicine and Respiratory Medicine of BIRDEM General Hospital, Dhaka, from July to December, 2022. Sixtytwo patients, aged e_18 years with CKD stage 3 to 5 with pleural effusion were included in this study. Patients having bleeding disorder, recent myocardial infarction or patients unwilling for thoracocentesis were excluded. Patients were evaluated clinically and by aspiration of pleural fluid. Results: Of the 62 patients, 42 (67.7%) were male and 20 (32.3%) were female. The mean age was 52 years. Commonest symptom was dyspnea (47, 75%), cough (33, 53%), weight loss (23, 37%) anorexia (22, 35%), fever (16, 25%), pleuritic chest pain (15, 24%), bilateral basal crepitations (15, 24%), abdominal swelling (9, 14%), engorged neck veins (7, 11%). Diabetes mellitus (DM) (50, 80%) was the commonest comorbidity in our patients. A previous history of TB was present in 9 (14%) patients (most of whom completed treatment) and 7 patients had history of malignancy (including 2 on treatment). In our study, 38 (61%) patients were in CKD stage 4, 6 (9%) patients were on dialysis. In most cases (51, 81%), effusions were bilateral transudative. Fluid overload (32, 62%), heart failure (29, 56%) and nephrotic syndrome (11/21%) were common transudative effusion. Etiology of exudative pleural effusion were TB, uremia, empyema and hypothyroidism. Conclusion: Aetiologiy of pleural effusion in CKD are mostly fluid overload, heart failure, nephrotic syndrome, TB and empyema. BIRDEM Med J 2025; 15(1): 39-43

2660 Drug classes associated with geriatric readmissions: the canary in a coal mine

Abstract Introduction Older adults are at increased risks of drug-related problems, contributed by increasing incidence of multimorbidity with age, and the consequent polypharmacy. We aim to investigate the drug classes associated with 30-day readmissions in hospitalised older adults. Method We prospectively studied patients aged 65 years and above admitted to a general medical department in Sengkang General Hospital, Singapore, between October 2018 and January 2020. Medication lists were obtained from electronic medical records at admission. Unplanned readmission within 30 days of discharge was tracked through the hospital’s electronic health records. Medications were classified according to the World Health Organisation’s Anatomical Therapeutic Chemical classification system. Univariate logistic regression was performed for the association of drug classes with 30-day readmission. Results We recruited 1507 consecutive admissions with follow-up data. 30-day readmission occurred in 331 patients (22.0%). Greater length of stay, higher comorbidity burden, hospitalisation in the year preceding index admission, frailty and polypharmacy were more commonly observed among patients who were readmitted within 30 days of discharge. Admission diagnoses associated with 30-day readmission include infections, fluid overload, acute coronary events and constipation. Drg classes associated with a higher risk of 30-day readmission include drugs for acid-related disorder (OR = 1.62, 95%CI 1.27–2.07), drugs for constipation (OR = 1.96, 95%CI 1.41–2.73), antithrombotic agents (OR = 1.40, 95%CI 1.09–1.79), antianaemic preparations (OR = 2.22, 95%CI 1.68–2.91), cardiac therapy (OR = 1.70, 95%CI 1.23–2.34), diuretics (OR = 1.41, 95%CI 1.04–1.90), beta-blocking agents (OR = 1.55, 95%CI 1.21–1.99) and analgesics (OR = 1.56, 95%CI 1.02–2.39). Conclusion Drg classes associated with 30-day geriatric readmissions include drugs for acid-related disorder, constipation, antithrombotic agents, antianaemic preparations, cardiac therapy, diuretics, beta-blocking agents and analgesics. Patients on the above drug classes should herald a higher index of scrutiny during admissions and necessitate closer follow-up upon discharge.

Risk factors of ventilator-associated events in patients on mechanical ventilation: A scoping review.

Ventilator-associated events (VAE) are associated with higher mortality rates. Understanding the risk factors for VAE provides preventive strategies for reducing them. Several studies have been conducted on VAE risk factors. However, the findings were inconsistent. This scoping review aimed to explore the existing evidence on risk factors of VAEs in intensive care unit (ICU) patients. Searches were performed across eight databases including Pubmed, ProQuest, Scopus, ScienceDirect, BMJ, Web of Science, Taylor & Francis and Ebsco from 26 March to 5 April 2024, complemented by backward and forward citation tracking-eligible studies criteria: participants aged 18 years and older reporting on VAE risk factors. The publication must have occurred between 2013 and 2024, be available as full text and be written in English. A total of 19 studies met the inclusion criteria and were analysed. Forty-four risk factors were identified. Decreased level of consciousness, chronic lung diseases, invasive operation, duration of MV, trauma, fluid overload, reintubation, enteral feeding, administration of sedation and stress ulcer prophylaxis were the most frequently reported risk factors for VAE. This review identified several potential risk factors for VAE; some factors have varying results or lack evidence. Further research is needed to confirm the role of these factors in reducing VAE or to clarify inconsistent findings. These findings provide information on the risk factors for VAE. Nurses must identify the presence of these risk factors in all adult ICU patients receiving invasive mechanical ventilation (IMV) and manage them to prevent the occurrence of VAE.

Digital twin driven electrode optimization for wearable bladder monitoring via bioimpedance

Monitoring fluid intake and output for congestive heart failure (CHF) patients is an essential tool to prevent fluid overload, a principal cause of hospital admissions. Addressing this, bladder volume measurement systems utilizing bioimpedance and electrical impedance tomography have been proposed, with limited exploration of continuous monitoring within a wearable design. Advancing this format, we developed a conductivity digital twin from radiological data, where we performed exhaustive simulations to optimize electrode sensitivity on an individual basis. Our optimized placement demonstrated an efficient proof-of-concept volume estimation that required as few as seven measurement frames while maintaining low errors (CI 95% −1.11% to 1.00%) for volumes ≥100 mL. Additionally, we quantify the impact of ascites, a common confounding condition in CHF, on the bioimpedance signal. By improving monitoring technology, we aim to reduce CHF mortality by empowering patients and clinicians with a more thorough understanding of fluid status.

Accuracy of nursing diagnoses identified at admission and discharge of patients with decompensated heart failure.

To determine the accuracy of nursing diagnoses at hospital admission and discharge for patients with heart failure (HF). This comparative study examined the documentation in 155 medical records of patients with an admitting diagnosis of HF during August 2018 and July 2019. An audit tool was used to record the diagnoses made by nurses during routine care at the time of admission and discharge. Two researchers (L.S. and A.C.) examined the records and evaluated the documented nursing diagnoses using the Nursing Diagnosis Accuracy Scale version 2. Kappa was used for agreement between them. Patient social and clinical characteristics were described using percentages, absolute frequencies, means, and standard deviations. A total of 18 unique nursing diagnoses were identified across the 155 patients. Among the 754 nursing diagnoses recorded, 85% of those identified at admission (n=644) were deemed highly accurate. At discharge, of the 527 diagnoses recorded, 66% (n=349) were rated as highly accurate. Excess fluid volume was the most common diagnosis (85% at admission, 49% at discharge). Three risk diagnoses were frequent at both points: risk for infection, risk for falls, and risk for decreased cardiac output. Agreement between evaluators ranged from Κ=0.234 to 1.00. Greater agreement in nursing diagnoses at discharge likely reflects ongoing patient monitoring. Persistent diagnoses at discharge highlight the need for continued nursing care post-discharge. This study encourages nurses to improve clinical evaluation for HF patients from admission to discharge. As key clinical indicators are identified, nurses can improve the accuracy of their diagnoses and plan more effective interventions to achieve positive health outcomes and reduce unnecessary hospitalization.

Association between intraoperative fluid management and postoperative outcomes in living kidney donors: a retrospective cohort study

Optimal fluid strategy for laparoscopic donor nephrectomy (LDN) remains unclear. LDN has been a domain for liberal fluid management to ensure graft perfusion, but this can result in adverse outcomes due to fluid overload. We compared postoperative outcome of living kidney donors according to the intraoperative fluid management. Five hundred and five LDNs performed over a six-year period at a tertiary hospital were analyzed. Donors were divided into tertiles according to intraoperative crystalloid infusion rate (ml/kg/hr), and associations between the tertile and outcomes were investigated with inverse probability of treatment weighting with entropy balancing. Primary outcome was maximal rise of serum creatinine (sCr). Secondary outcomes were sCr rise meeting Acute Kidney Injury (AKI) criteria, time to reach minimal sCr, and length of hospital stay. The following covariates were used: age, sex, body weight, height, diabetes mellitus, hypertension, preoperative estimated glomerular filtration rate, operation duration, surgeon, nephrectomy side, and estimated blood loss. Median intraoperative crystalloid infusion rate was 3.5, 4.6, and 6.0 ml/kg/hr in the first, second, and third tertile, respectively (group 1, 2, and 3). Maximal rise of sCr did not differ between groups (P = 0.274). Twofold increase in sCr (equivalent to stage 2 AKI) during the first week and prolonged hospitalization were most frequent in group 1 [7.8 vs. 1.1 vs. 1.5%, P = 0.004; 7.9 vs. 3.1 vs. 0.7%, P = 0.003]. Time to reach minimal sCr was longest in group 1. No differences were found in recipient early renal function. Hypovolemia is associated with poor postoperative outcomes after LDN. Efforts to find the optimal fluid management should be continued.

The adductor pollicis muscle thickness is not associated with physical function, lean mass, and nutritional status in patients on maintenance hemodialysis

BackgroundThe adductor pollicis muscle thickness (APMT) may be associated with the muscle strength in patients on hemodialysis. However, the association of APMT with other physical function assessment tests has not yet been tested. Moreover, because it is considered a good nutritional indicator and not influenced by fluid overload, the APMT may be associated with the muscle mass and nutritional status of these patients. Therefore, the objective was to assess the association of APMT with physical function, muscle mass and nutritional status in patients on hemodialysis.MethodsThe APMT was measured using a skinfold caliper between pollicis finger and index finger. Physical function was evaluated by handgrip strength (HGS), Short Physical Performance Battery (SPPB), the sit-to-stand test, gait speed test, and timed up and go (TUG). Appendicular muscle mass index (AMMI) was estimated using bioelectrical impedance. The nutritional status was evaluated by the Malnutrition Inflammation Score (MIS).ResultsFifty-one patients were included, 60.8% men, mean age 58.4 ± 12.6 years. There were no significant correlations of APMT with physical function, muscle mass and nutritional status. Values of APMT were not different between the groups according to adequate physical function or muscle mass. In the multiple linear regression analysis adjusted for sex, age and diabetes, APMT was not significantly associated with physical function tests, as HGS (β = 0.101; p = 0.778), gait speed (β = −0.014; p = 0.180), SPPB (β = −0.054; p = 0.590), TUG (β = 0.202; p = 0.109), lean mass AMMI (β = 0.058; p = 0.147).ConclusionThere were no associations of APMT with physical function, muscle mass and nutritional status in patients on hemodialysis. We suggest APMT should not be used in physical function and nutritional assessments of these patients.

Significant Dry Weight Reduction After Transition from Peritoneal Dialysis to Hemodialysis.

Background Dry weight management in dialysis patients is crucial but often subjective, primarily based on symptoms. Due to continuous fluid removal in peritoneal dialysis (PD) and intermittent ultrafiltration in hemodialysis (HD), symptom-based assessments may be biased, leading to varying results. Surprisingly, no direct comparison of dry weight changes between PD and HD has been conducted. This study aims to evaluate the impact of transitioning from PD to HD on body weight and related clinical parameters. Methods This retrospective cohort study included 127 stable PD patients who transitioned to HD. Changes in body weight, echocardiographic parameters, albumin, and hemoglobin levels were analyzed over a one-year period post-transition. Results The mean patient age was 57.1 ± 15.5 years, with an average PD vintage of 5.8 ± 4.9 years. Most patients had hypertension. After transitioning to HD, body weight decreased significantly, with a reduction of -2.8 kg at one month, -5.3 kg at three months, and -7.5 kg one year post-transition. Echocardiographic parameters showed no significant changes. However, serum albumin and hemoglobin levels increased slightly but significantly after the transition, and the number of antihypertensive medications was also reduced. Conclusion The transition from PD to HD results in significant reductions in body weight. These findings underscore the often-overlooked issue of fluid overload in PD patients and its potential impact on patient outcomes.

Fluid Management Bundle in Critically Ill Children With Respiratory Failure Is Associated With a Reduced Prevalence of Excess Fluid Accumulation.

To report the feasibility of a fluid management practice bundle and describe the pre- vs. post-implementation prevalence and odds of cumulative fluid balance greater than 10% in critically ill pediatric patients with respiratory failure. Retrospective cohort from May 2022 to December 2022. Quaternary care PICU in Pittsburgh, PA. Children older than 28 days receiving invasive mechanical ventilation for greater than 48 hours. None. We reviewed data from 205 patients; 104 before bundle implementation and 101 after bundle implementation. At the time of implementation in 2022, our PICU clinicians were educated on the use of the fluid management practice bundle, which included the following during daily rounds: goal-setting for daily fluid balance; assessing transition to enteral nutrition; and fluid conservation measures such as concentrating infusions or using enteral formulations of medications. A cumulative fluid balance greater than 10% occurred in 46 of 104 patients (44%) pre-implementation and 26 of 101 patients (26%) post-implementation. We failed to identify an association between implementation epoch grouping (pre- and post-) and adverse outcomes, including mortality, duration of mechanical ventilation, acute kidney injury, and ICU length of stay. In a multivariable logistic regression model, management during the fluid management bundle was associated with lower odds of a cumulative fluid balance greater than 10% (adjusted odds ratio, 0.35 [95% CI, 0.18-0.68]). In our PICUs 2022 peri-implementation testing of a fluid management bundle in critically ill children with respiratory failure, we have first found that such a practice change is feasible. Second, we identified an associated decrease in the prevalence and lower odds of fluid accumulation. We continue to use this fluid management bundle in our center but more widespread prospective studies are needed to test the benefit in clinical practice.

Sacubitril/valsartan on right ventricular-pulmonary artery coupling and albumin-bilirubin score in heart failure in Chinese patients with reduced ejection fraction

ObjectiveImpaired right ventricular (RV)-pulmonary arterial (PA) coupling, calculated by measuring the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), can be used as an early indicator of right ventricular dysfunction (RVD) in patients with heart failure with a reduced ejection fraction (HFrEF). Patients suffering from HFrEF experience improvements in left ventricular (LV) function through the administration of sacubitril/valsartan therapy. In addition, the albumin-bilirubin (ALBI) score was associated with the fluid overload status and adverse clinical outcomes in patients with heart failure. This study aimed to assess whether angiotensin receptor-neprilysin inhibitor (ARNI) affects the TAPSE /PASP in patients with HFrEF, and whether there is a correlation between changes in the ALBI score and ARNI treatment.MethodsA retrospective observational study was conducted on 305 patients with HFrEF and RVD who were hospitalized between June 2020 and December 2021. One year after treatment, laboratory test results, ALBI score, transthoracic echocardiography (TTE), New York Heart Association classification, Minnesota Living with Heart Failure Questionnaire scores and changes in relevant variables were reevaluated.ResultsCompared to before sacubitril/valsartan treatment, the ALBI was found to be significantly reduced after one year of follow-up (-2.42 ± 0.37 vs. -2.51 ± 0.32, p < 0.001). Additionally, A significant improvement was demonstrated in the following echocardiography parameters assessing RV function after 1 year of treatment with sacubitril/valsartan: TAPSE (15 ± 1 vs. 18 ± 2 mm, p < 0.001), PASP (45 ± 8 vs. 40 ± 9 mmHg, p < 0.001), pulmonary artery diastolic pressure (PADP) (22 ± 4 vs. 19 ± 4 mmHg, p < 0.001), RV-PA coupling (0.35 ± 0.08 vs. 0.48 ± 0.12, p < 0.001), and RV s’(8.7 ± 2.2 vs. 9.5 ± 2.6 cm/s, p < 0.001). Multivariate analysis showed that the improvement of RV-PA coupling was associated with baseline PASP (r: -0.45, p < 0.001) and PADP (r: -0.45, p < 0.001).ConclusionsSacubitril/valsartan improves RV-PA conjugation in patients with RVD and HFrEF, and has a positive impact on the ALBI score by improving liver function in patients with HFrEF.

Subcutaneous Pectoral Edema After Arthroscopic Labral Repair Despite Normal Irrigation Fluid Usage and Surgery Duration.

Edema after shoulder arthroscopic surgery poses concerns due to its potential complications such as compartment syndrome, nerve damage, and respiratory issues. This study aimed to investigate the acute accumulation of subcutaneous fluid after shoulder arthroscopy. A prospective cohort study, providing Level III evidence was conducted on 50 patients undergoing arthroscopic shoulder surgery under interscalene block anaesthesia from September to December 2023. The patients were divided into two groups: rotator cuff repair (RCR, n = 29) and labral repair for shoulder instability (LR, n = 21). Subcutaneous fluid levels were measured preoperatively, postoperatively, and at discharge (24 h postsurgery) using the MoistureMeterD Compact at the neck, pectoral region, deltoid area, cubital fossa, and carpal tunnel. Data on surgery duration and irrigation fluid volume were documented. In the statistical analysis, repeated measures ANOVA and the independent-samples t-test were applied to compare parametric data, while the Friedman test and Mann-Whitney U test were used for nonparametric data. The average operation time was 29.0 ± 12.1 min for RCR and 30.0 ± 10.9 min for LR, with average irrigation fluid use of 3.8 ± 0.9 and 4.0 ± 0.7 L, respectively (both p > 0.05). There was no increase in subcutaneous edema in the neck and deltoid region in both groups. At discharge, the percentage of subcutaneous fluid increased in the cubital fossa (p = 0.04 for RCR; p < 0.001 for LR) and carpal tunnel (both p < 0.001) in oth groups, whereas pectoral edema increased only in the labral repair group (p = 0.04). Subcutaneous pectoral edema can occur following arthroscopic labral repair, and increased fluid levels in the cubital fossa and carpal tunnel were observed in both rotator cuff and labral repairs, even in the absence of prolonged surgery or excessive irrigation fluid use. These findings highlight the need for careful postoperative management of edema after shoulder arthroscopy, particularly for labral repairs, with special attention to the pectoral region, cubital fossa, and carpal tunnel to prevent potential complications. The registry is sponsored by the United States National Library of Medicine (www. gov); Registry Name: Examination of Edema After Arthroscopic Shoulder Surgery ID: NCT06014203.